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LAB DIAGNOSIS IN
ALCOHOLIC LIVER DISEASE
RESOURCE FACULTY-Dr.S.MAJHI PRESENTED BY-PRATEEK SINGH
OBJECTIVE
To enumerate the biochemical parameters for diagnosis of ALD
To interpret the above parameters
BIOCHEMICAL TESTS
TEST FOR LIVER BIOSYNTHETIC ACTIVITY
*Serum bilirubin
*Serum albumin
*Albumin/Globulin ratio
*Prothrombin time
SERUM ENZYME TEST*Aspartate aminotransferase (AST)
*Alanine amino transferase (ALT)
* Alkaline phosphatase (ALP)
* Gammaglutamyl transferase (GGT)
*5'nucleotidase (5'-NT)
*DE-RITIS ratio (AST/ALT)
INTERPRETATIONS OF BIOCHEMICAL FINDINGS
DE-RITIS RATIO*THIS IS THE MOST IMPORTANT
BIOCHEMICAL INDICATOR OF ALCOHOLIC LIVER DISEASE.
*This is the ratio of Aspartate aminotransferase and Alanine aminotransferase
*In normal individuals the DE-RITIS ratio is 1.10:1
*But in patients of alcoholic liver disease it is more than 2.
*Studies in regard to deritis ratio has also been conducted in b.p.k.i.h.s by. Dr S.majhi, Dr N.Baral and Dr Lamsal
ALKALINE PAHOSPHATASE*Not specific for liver disease
*Normal value is 25-90IU/l
*It will be elevated in ALD
*If its rise is in parallel to GGT it can be said that this elevation is due to ALD.
ASPARTATE AMINOTRANSFERASE
*Normal value is 35.00 +/- 23.49 IU/L *It will be elevated in ALD 2-7 folds, but not more than 400IU/L
*AST will be elevated more than ALT
ALANINE AMINOTRANSFERASE
*Normal value is 31.48 +/- 17.79 IU/L *It will be elevated 2-5 folds in ALD, but not more than 400IU/L.
GAMMA GLUTAMYLTRANSFERASE
*Normal value is 70.55 +/- 27.35 IU/L
*It will be moderately increased in chronic alcoholics & All forms of fatty liver.
*It is an Inducible enzyme.
*So,it is not a specific marker of ALD
BILLIRUBIN*Normal serum concentration is
0.3-1mg/dl*It will be increased in ALD >5mg/dl.ALBUMIN*Normal serum concentration is 3.5-
5gm/dl*It decreases in ALD upto 2-3gm/dl
GLOBULIN*Serum globulin will increase during
liver disease in response to antigenic stimulation reflecting the immune changes associated with alcoholic liver disease.
*Normal Globulin level is 2.5-3.5gm/dl
OUT OF THREE GAMMA GLOBULIN
IgA-Increases in 90% of cases.
IgG-Increases in 64% of cases.
IgM-Increases in 25% of cases.
ALBUMIN GLOBULIN RATIO The normal A/G ratio is 1.2-1.5:1
*But in alcoholic liver disease this ratio is
reversed
PROTHROMBIN TIME *Normal Prothrombin time is 12-16secs.
*In ALD Prothrombin time increases
Due to decrease synthesis of clotting factors.
INTERPRETATION CHART
MILD MODERATE SEVERE
GGT 70.35+/-17.79 IU/L
AST 35+/-23.49 IU/L
ALT 31.48+/-17.79 IU/L
MILD MODERATE SEVERE
ALP25-90U/L
BILLIRUBIN25-90U/L
N
PROTHROMBIN TIME12-16secs
MILD MODERATE SEVERE
SERUM ALBUMIN3.5-5gm/dl
5‘NUCLEOTIDase0-11mg/dl
THANK YOUTHANK YOU